Drainless Thoracoscopic Lobectomy for Lung Cancer

Long-term outcomes of drainless anatomical lung resection surgery for pulmonary malignancies

OBJECTIVE

Drainless minimally invasive anatomical lung resection surgery for pulmonary malignancies is safe and feasible in terms of early postoperative outcomes. However, the quality of surgery in the long term remains uncertain. This study aimed to investigate the perioperative outcomes, 3-year overall, and disease-free survival rates of patients who underwent minimally invasive anatomical lung resection surgery with the drainless technique for pulmonary malignancies.

METHODS

Fifty-eight patients who underwent drainless minimally invasive anatomical lung resection surgery for pulmonary malignancies (36 -lobectomy; 22 -segmentectomy) between November 2017 and June 2022 by a single surgeon were enrolled. Patients' characteristics and perioperative, early postoperative, and long-term data were collected. The lymph node dissection stations and number, resection margin, 3-year overall and disease-free survival rates were assessed.

RESULTS

The median age was 64 years. Forty-four patients were females (76%) and forty-seven patients were non-smokers (81%). The median five-factor modified frailty index was 1. Most patients had primary lung cancer; four (7%), 43 (74%), seven (12%), and three (5%) had stage 0, I, II, and III, respectively. The median lymph node dissection stations was four, and the number was 17. The resection margin was free in 98% of the cases. The 3-year overall survival rate was 98.3% in all patients, and 97.2% and 100% in the lobectomy and segmentectomy subgroups, respectively. The 3-year disease-free survival rate was 85.3% in all patients and 80.5% and 92.9% in the lobectomy and segmentectomy subgroups, respectively.

CONCLUSION

The drainless technique is safe and feasible for minimally invasive anatomical lung resection surgery for pulmonary malignancies in terms of early postoperative and long-term outcomes. However, further randomized controlled studies are warranted.

Preliminary outcomes of drainless videothoracoscopic pulmonary wedge resection procedure from Turkey

Introduction

A chest tube inserted through the intercostal space for air and blood evacuation after thoracic surgery is a serious cause of postoperative pain and prolongs the length of stay. Drainless video-assisted thoracoscopic thoracic surgical procedures, which were previously performed in mediastinal surgical procedures, have also been applied for lung resections in recent years.

Aim

To investigate the superiority of drainless videothoracoscopic pulmonary wedge resection over those with a drain in terms of postoperative pain and length of stay.

Material and methods

Data of patients who underwent video-assisted thoracoscopic (VATS) pulmonary wedge resection between December 2022 and May 2023 in our department were retrospectively reviewed. Age, gender, operation indication, postoperative complication, number of wedge resections, visual pain score, and length of hospital stay data were collected. Patients were divided into two groups: drainless and with-drain. The existence of differences or correlations between groups was investigated by the Pearson χ2, student' t-test, or Mann-Whitney-U test according to type or distribution of data.

Results

A total of 35 patients were included in the study. There were 14 patients in the drainless group and 21 in the with-drain group. Postoperative pain score and length of stay were significantly lower in the drainless group (p < 0.001). There was no significant difference between the groups in terms of age, gender, presence of complications, or number of wedge resections (p > 0.5).

Conclusions

Drainless VATS pulmonary wedge resections are safe methods that offer less postoperative pain and shorter hospital stays compared to with-drain methods.